West Colin P, Huschka Mashele M, Novotny Paul J, Sloan Jeff A, Kolars Joseph C, Habermann Thomas M, Shanafelt Tait D
Division of General Internal Medicine, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
JAMA. 2006 Sep 6;296(9):1071-8. doi: 10.1001/jama.296.9.1071.
Medical errors are associated with feelings of distress in physicians, but little is known about the magnitude and direction of these associations.
To assess the frequency of self-perceived medical errors among resident physicians and to determine the association of self-perceived medical errors with resident quality of life, burnout, depression, and empathy using validated metrics.
DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic Rochester. Data were provided by 184 (84%) of 219 eligible residents. Participants began training in the 2003-2004, 2004-2005, and 2005-2006 academic years and completed surveys quarterly through May 2006. Surveys included self-assessment of medical errors and linear analog scale assessment of quality of life every 3 months, and the Maslach Burnout Inventory (depersonalization, emotional exhaustion, and personal accomplishment), Interpersonal Reactivity Index, and a validated depression screening tool every 6 months.
Frequency of self-perceived medical errors was recorded. Associations of an error with quality of life, burnout, empathy, and symptoms of depression were determined using generalized estimating equations for repeated measures.
Thirty-four percent of participants reported making at least 1 major medical error during the study period. Making a medical error in the previous 3 months was reported by a mean of 14.7% of participants at each quarter. Self-perceived medical errors were associated with a subsequent decrease in quality of life (P = .02) and worsened measures in all domains of burnout (P = .002 for each). Self-perceived errors were associated with an odds ratio of screening positive for depression at the subsequent time point of 3.29 (95% confidence interval, 1.90-5.64). In addition, increased burnout in all domains and reduced empathy were associated with increased odds of self-perceived error in the following 3 months (P=.001, P<.001, and P=.02 for depersonalization, emotional exhaustion, and lower personal accomplishment, respectively; P=.02 and P=.01 for emotive and cognitive empathy, respectively).
Self-perceived medical errors are common among internal medicine residents and are associated with substantial subsequent personal distress. Personal distress and decreased empathy are also associated with increased odds of future self-perceived errors, suggesting that perceived errors and distress may be related in a reciprocal cycle.
医疗差错与医生的痛苦情绪相关，但对于这些关联的程度和方向知之甚少。
评估住院医师自我感知到的医疗差错的频率，并使用经过验证的指标确定自我感知到的医疗差错与住院医师生活质量、职业倦怠、抑郁和同理心之间的关联。
设计、地点和参与者：对梅奥诊所罗切斯特分院的内科分类住院医师和初级住院医师进行的前瞻性纵向队列研究。219名符合条件的住院医师中有184名（84%）提供了数据。参与者于2003 - 2004年、2004 - 2005年和2005 - 2006学年开始培训，并在2006年5月之前每季度完成一次调查。调查包括每3个月对医疗差错的自我评估和生活质量的线性模拟量表评估，以及每6个月进行的马氏职业倦怠量表（去个性化、情感耗竭和个人成就感）、人际反应指数和经过验证的抑郁筛查工具。
记录自我感知到的医疗差错的频率。使用重复测量的广义估计方程确定差错与生活质量、职业倦怠、同理心和抑郁症状之间的关联。
34%的参与者报告在研究期间至少犯了1次重大医疗差错。每个季度平均有14.7%的参与者报告在前3个月犯了医疗差错。自我感知到的医疗差错与随后生活质量的下降相关（P = 0.02），并且在职业倦怠的所有领域的测量指标都恶化（每个领域P = 0.002）。自我感知到的差错与随后时间点抑郁筛查呈阳性的比值比为3.29（95%置信区间，1.90 - 5.64）。此外，所有领域职业倦怠的增加和同理心的降低与接下来3个月自我感知到差错的几率增加相关（去个性化、情感耗竭和个人成就感降低分别为P = 0.001、P < 0.001和P = 0.02；情感同理心和认知同理心分别为P = 0.02和P = 0.01）。
自我感知到的医疗差错在内科住院医师中很常见，并且与随后的严重个人痛苦相关。个人痛苦和同理心降低也与未来自我感知到差错的几率增加相关，这表明感知到的差错和痛苦可能在一个相互的循环中相关联。
